April and Alex are scrubbing in for their procedure and April persists in trying to give Alex some personal details about the guy he's about to cut open. The reason his wife isn't there is that she died of a stroke, and Jason only had one semester left in college but he dropped out to help his dad. Alex seems disgusted that April has the gall to personalize a case but April lectures him that this is about more than an easy A or a bet he can win. She reminds him that this is, in fact, his job but he feels quite differently and says it's just his job to open and fix the person; he could spend time talking or he could spend his time figuring out what to do. April finally realizes that at least today, Alex's bad attitude is actually a show of bravado to mask his fear at being in charge for the first time. She assures him that he will be fine. Richard then pops in to tell Alex that he's loving his book and if Alex doesn't screw up, he will get to finish it up during surgery. He asks Alex point-blank if he'll finish the book and Alex unconvincingly tells him yes.
The scrub room is not a happy play today; as Derek and Meredith get ready he asks if she's looked at the scans but when she says yes, he immediately says he wants to take a look again. That's all the undermining Meredith needs and she tells him calmly that she thinks he should do the surgery. He practically spits, "Why?" She really is damned if she does, damned if she doesn't with him; he's predisposed to go against anything she says or does. Meredith points out that they aren't a team right now and really, sounds like the much more mature adult in this conversation. Derek asks her some questions about the procedure and when she answers he curtly tells her she's ready, so let's go. But he didn't really mean the "us" part of "let's" as evidenced by the fact that he walks into the OR and lets the door shut in her face.
April and Alex walk inside and he seems pissed that she's standing in his spot until she hisses at him that as lead, he goes on the other side. This might be a small issue as he practiced the procedure from the spot where April is standing. But when Richard asks if there is a problem Alex quickly says no and picks up the knife.
Not one of these residents is enjoying working with their Attending right now -- Teddy keeps asking Cristina to tell her all of the steps of the appendectomy as she performs them and warns Cristina that this isn't going to get old. Well, not for herself, at least.